The novel coronavirus disease 2019 (COVID‐19) is associated with increased risk of thromboembolic events, but the extent and duration of this hypercoagulable state remain unknown. We describe the first case report of renal allograft infarction in a 46‐year‐old kidney–pancreas transplant recipient with no prior history of thromboembolism, who presented 26 days after diagnosis of COVID‐19. At the time of renal infarct, he was COVID‐19 symptom free and repeat test for SARS‐CoV‐2 was negative. This case report suggests that a hypercoagulable state may persist even after resolution of COVID‐19. Further studies are required to determine thromboprophylaxis indications and duration in solid organ transplant recipients with COVID‐19.

Background The impact of posttransplant red blood cell transfusion (RBCT) and their potential immunomodulatory effects on kidney transplant recipients are unclear. We examined the risks for adverse graft outcomes associated with post-kidney transplant RBCT. Methods We conducted a retrospective cohort study of all adult kidney transplant recipients at The Ottawa Hospital from 2002 to 2018. The exposure of interest was receipt of an RBCT after transplant categorized as 1, 2, 3 to 5, and >5 RBC. Outcomes of interest were rejection and death-censored graft loss (DCGL). Cox proportional hazards models were used to calculate hazard ratios (HR) with RBCT as a time-varying, cumulative exposure. Results Among 1258 kidney transplant recipients, 468 (37.2%) received 2373 total RBCTs, 197 (15.7%) had rejection and 114 (9.1%) DCGL. For the receipt of 1, 2, 3 to 5, and >5 RBCT, compared with individuals never transfused, the adjusted HRs (95% confidence interval [CI]) for rejection were 2.47 (1.62–3.77), 1.27 (0.77–2.11), 1.74 (1.00–3.05), and 2.23 (1.13–4.40), respectively; DCGL 2.32 (1.02–5.27), 3.03 (1.62–5.64), 7.50 (4.19–13.43), and 14.63 (8.32–25.72), respectively. Considering a time-lag for an RBCT to be considered an exposure before an outcome to limit reverse causation, RBCT was not associated with rejection; the HRs for DCGL attenuated but remained similar. RBCT was also associated with a negative control outcome, demonstrating possible unmeasured confounding. Conclusion RBCT after kidney transplant is not associated with rejection, but may carry an increased risk for DCGL.

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